At the 2015 AMA Annual Meeting, physicians passed policy calling on the Centers for Medicare & Medicaid Services (CMS) not to withhold claim payments based on coding errors, mistakes or malfunctions in the system for two years directly following implementation.

With less than four months to go before the deadline for implementing the ICD-10 code set, physicians agreed to seek a two-year grace period to avoid financial disruptions and facilitate a smoother transition. The grace period would allow physicians to continue providing quality care to their patients rather than sideline their patients to meet the harrowing details of implementation.

A 2014 AMA study conducted by Nachisom Advisors on the cost of implementing ICD-10 estimated that a small practice could see payment disruptions ranging from $22,579 to $100,349 during the first year of ICD-10 implementation. The study also estimates that a small practice could incur a 5 percent drop in revenue because of productivity loss during and after the change.

Related policy from the meeting also pushes the AMA to advocate for physician voices to be part of the group that manages the International Classification of Diseases (ICD). Currently, the four cooperating parties that manage ICD code sets are the Centers for Disease Control National Centers for Health Statistics, CMS, the American Hospital Association and the American Health Information Management Association. A physician group is necessary in these conversations because none of the current groups represent providers who have licensed authority to define, diagnose, describe and document patient conditions and treatments.

CMS has acknowledged that the transition to ICD-10 will have an impact on physician payment processes. The agency estimates that “in the early stages of implementation, denial rates will rise by 100-200 percent,” according to a 2013 report from the Healthcare Financial Management Association.

“The bottom line is that ICD-10 will significantly overwhelm physician practices with a 400 percent increase in the number of codes physicians must use for diagnosis, which will take time away from the valuable one-on-one patient-physician interface that is the hallmark of taking the best care of patients,” states Russell Kridel, MD, member of the AMA Board of Trustees. “We continue to press both Congress and the administration to take necessary steps to avoid widespread disruption to physician practices created by this overly complex and burdensome mandate. Coding and billing protocols should never get in the way of patients receiving high quality care.”

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

Signs of Life for Sugar Sweetened Beverage Consumption Trends

A recent research study by Sara N. Bleich, PhD, et al at Johns Hopkins Bloomberg School of Public Health shows that simple signs that link exercise to sugar-sweetened beverage consumption does help teens make healthier choices. Fortunately, this study was picked up by multiple media outlets noted below, adding needed exposure to the detrimental effects of sugar-sweetened beverages.

HealthDay (10/17, Preidt) also reports on the study, saying researchers installed signs “in six corner stores in low-income, predominately black neighborhoods in Baltimore” informing consumers about calories, sugar and the exercise needed to burn off a soda. Of the teens interviewed after a drink purchase, “59 percent said they believed the information on the signs and 40 percent said they changed their purchases as a result.”

BBC News (10/17) reports on the research and said “the most effective sign said it took five miles to walk off the 250 calories in a sugary drink.”

CNN (10/16, Wilson) reports, while “more than 20 chain restaurants will be posting calorie counts on their menus” by next year, the research suggests “the number of calories in a food or beverage item doesn’t mean much to many folks.” However, showing people how much physical activity is needed to burn those same calories makes a difference.

Instead of lecturing the population about the overarching concept of the health impact of excessive sugar intake and the science behind it, this study further substantiates the need to simplify the message in a manner that is relevant to the constituency. Stating that you have to walk 3 miles to burn off the 227 calories of a 20 ounce soda, is far more effective and powerful than just stating calorie counts

In Harris County, the HCMS “Shut Out Sugar” Program, takes a similar approach, using local landmarks as examples of distances to run to burn off calories consumed by sugar sweetened beverages. You can read more about the “Shut Out Sugar” campaign at sugarshutout.org or a previous KridelOnHealth.com post.

Another positive step in addressing personal responsibility is the fact that several restaurant chains have not only begun to post calorie counts, but some have also started to show people how much physical activity is needed to burn those same calories.

The more exposure this topic gets the greater the impact on the fight against obesity.

Houston facial plastic surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

Doctors Without Borders Impact on Ebola Outbreak is Laudable

It was nice to see the October 16th LA Times article recognize the heroic efforts of Doctors without Borders in the fight against the spread of Ebola. There has been so much news focus on issues relating to the consequences of the disease, such as the latest patient to be diagnosed or restrictions on travel, that we have taken our eye off of the need to support those doctors and healthcare workers on the front line in West Africa at Ground Zero. To stop the epidemic here we must stop the epidemic there.

As physicians and healthcare professionals, we often face life-threatening situations in our practices. But, to place yourself into a hot zone, like what is seen in West Africa as well as in hospitals here in the U.S., and risk your life every minute of every day to help treat patients with Ebola, as well as develop techniques to prevent it, is exceptional. I am humbled by their bravery.

WHAT CAN WE DO TO HELP

For all of us not getting on a plane this moment to enlist in the fight, there are actions we take. We can help support Doctors Without Borders or others, such as the CDC Foundation. These organizations need supplies, such as; gloves, gowns, suits and masks for their own protection. And they need medications, such as; saline, oxygen and antibiotics for the patients. All this costs money.

Through letters and phone calls, we can also encourage our government representatives to take a leadership position in addressing Ebola through financial aid, troops, public health service providers, as well as, enlisting other nations support.

We can be informed, so we can can inform our patients and others. There is an Ebola Resource Center on the AMA website that is a good reference tool.

Whether a donation or other charitable action is in part due to self-interest, that we do not want the virus to spread rampantly here in the U.S. Or, in part due to guilt, that we aren’t one of the doctors or healthcare workers on the ground. Or, in part out of compassion, to help avert a preventable medical disaster. The reason does not matter. Because, in a fight like this every dollar, every volunteer hour, every letter and every phone call counts.

Houston facial plastic surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

Calls for E cigarette Regulation Intensifies

Tougher e cigarette regulation needed

I applaud the efforts of more than two dozen state attorneys efforts to have the FDA impose tougher restrictions on e-cigarettes, outlined in the August 9, 2014 Wall Street Journal article, “States Urge Tougher Curbs on E-cigarettes.”

The 33 page letter sent to the Federal Drug Administration (FDA) last week was submitted by the group representing 29 states and proposed tougher restrictions on matters such as, marketing of e-cigarettes, characterization of flavors and sale of tobacco products (including e-cigarettes) over the Internet. These restrictions are tougher than those proposed by the FDA in April of this year.

Also, over the past two weeks, several members of Congress also sent a letter to the FDA calling for restrictions on marketing to children, flavored e-cigarettes and online sales. Numerous other groups, including the AMA, have called for greater restrictions prior to the recent end of the FDA public comment period on the e-cigarette restrictions proposed in April.

However, e-cigarette proponents, including tobacco companies, are also bombarding the FDA to stop them from adding restrictions, claiming — erroneously — that e-cigarettes have health benefits (for example, help with smoking cessation).

While the FDA proposed restrictions in April are a first step toward regulation of the burgeoning e-cigarette industry, we need to keep the pedal to the metal on this issue to pressure the legislature and the FDA to implement greater restrictions on e-cigarettes as a matter important to public health and safety. We need to have our voice heard over the intense clout of the e-cigarette industry.

Information about E-cigarettes (and AMA Council on Science and Public Health) can also be found at scienceandyourhealth.com

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

Significant E cigarette health concerns

E cigarette health concerns are serious

There is virtually no scientific evidence that E-cigarette use is safe and harmless. On the contrary. The March, 2014 article in the New York Times, “Selling a Poison by the Barrel”, highlighted the fact that the “e-liquids” used as the key ingredient in e-cigarettes is a powerful neurotoxin. This liquid is nicotine in its potent, liquid form and it is easy to obtain with virtually no restrictions. Tiny amounts, such as a teaspoon, of even highly diluted e-liquid can kill a small child. And the fact that this liquid can be flavored and colored raises many alarms about the use and abuse of the substance by children. E-cigarette use among high school students in the U.S. more than doubled from 4.7% in 2011 to 10% in 2012, according to the Centers for Disease Control and Prevention’s National Youth Tobacco Survey. At least 160,000 students who never tried traditional cigarettes, used e-cigarettes.

Wild Wild West

Unlike nicotine gums and patches, e-cigarettes, as well as their ingredients, are NOT regulated. The Food and Drug Administration has yet to impose rules on e-liquids’ sale. Without regulations, it continues to be the Wild West for e-cigarette companies. They continue to roll out more brands in many different varieties and flavors and advertise heavily on high profile television shows, like the Super Bowl.

Buyer Beware

As early as 2010 the AMA Council on Science and Public Health (CSAPH) recognized the hazards of E-cigarettes to public health and recommended the following:

E-cigarettes be classified as (nicotine) drug delivery devices and should be subject to FDA 49 regulation with appropriate standards for identity, strength, purity, packaging, and labeling with instructions and contraindications for use, including age of the user.

State legislatures prohibit the sales of e-cigarettes and all other nicotine devices that are not FDA-approved

As currently marketed, e-cigarettes be included in smokefree laws but separately from defined from tobacco products

Prohibition of unsupported marketing claims as a tobacco cessation tool.

Further development of strategies to prevent marketing of electronic cigarettes and nicotine delivery systems to minors and stem the negative health effects of nicotine on minors.

As the debate rages on, big tobacco investors are buying up e-cigarette companies. The are now more than 100 e-cigarette companies jockeying for market share of both smokers and non-smokers. As stated in the May, 2014 article published in Scientific American, “Smoke Screen: Are E-cigarettes safe?” — the success of all these companies rests on the claim that e-cigarettes are healthier than traditional cigarettes. And, that simply has not been proven.

Something has to be done now, before the ship has sailed too far down what is now an open channel. The government needs to pass legislation regarding the sale and consumption of e-cigarettes. And, the FDA needs to step in and put regulations into place to protect the safety of public health including imposing rules on the sale of e-liquid.

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

Personal Responsibility and Healthcare: Behavior can make a big difference

Part of the cost control contemplated in the Affordable Care Act (ACA) is holding physicians accountable for cost and quality. But how can physicians be held accountable for non-compliant patients or patients who do not take responsibility for their own health? Personal responsibility and healthcare costs are inextricably linked. It is estimated that more than half of our health care expenditures are for self-induced medical problems. Smoking, drug and alcohol addiction, lack of exercise, noncompliance with prescribed medical treatment plans, and lack of caution to prevent potential injuries, all add billions of dollars to medical costs yearly. Obesity alone has taken on epidemic proportions, with the United States spending $174 billion a year to treat diabetes, and at least $147 billion on health problems related to overweight and obesity. Tobacco still costs this nation more than $150 billion a year. According to the Centers for Disease Control and Prevention (CDC), nearly 75 percent of Americans report they do not always take their medications as directed; one in three never fill their prescriptions; and proper adherence approaches only 50 to 65 percent in patients with chronic conditions, such as diabetes and hypertension An article in the New England Journal of Medicine (NEJM) reported that poor medication adherence contributes significantly to medication-related hospital admissions in the United States, at an estimated cost of at least $100 billion annually. Lifestyle behaviors are difficult to change, and solutions to effect behavioral modification have been largely unsuccessful to date, despite huge community efforts and even legislation. Some patients have developed a sense of entitlement of care, taking no responsibility for abusing their health but expecting every conceivable means of treatment be used to cure them, no matter the expense. They, in turn, blame the health care delivery system for its high costs. This is unfortunate, since there likely would be more than enough money in our health care system to help patients with illnesses that could not be prevented if the rest of our population practiced healthy living. Other patients would like to change but need to be taught what to do. Others face economic and cultural obstacles that prevent wellness, which we must address. As physicians, no matter what our specialty, we do have a strong role to play in every one of our patient encounters, because if we don’t discuss healthy living with our patients, who will? Only the individualized approach will work along with peer and affinity group influence. We physicians alone cannot accomplish this. We need the collaborative effort of community, parents, schools, hospitals, insurance companies and businesses.

Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.

Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.

Physicians Taking The Wheel for The Future of Medicine

As physicians we cannot view the future of medicine and the role we have to play by looking through the rear view mirror of yesterday. The view ahead belongs to those who face the fact of change, grab the wheel and move forward to shape it. And change is here, often obstructing our progress forward and causing many detours, which frustrates physicians as we try to provide the best care for our patients and advance science.

We used to be solely in the driver’s seat, helping our patients arrive at healthy destinations. But now, the person paying for the gas is no longer the patient, having been replaced by the government and third-party payers; they used to be just back seat drivers, annoyingly telling us where to make our turns. But more recently, they have made passengers of physicians; and they are behind the wheel. Unfortunately for patients and physicians alike, they don’t have a license and haven’t even had drivers’ education. Your leaders in organized medicine will be working harder than ever to put you back in the driver’s seat to lead the health care car safely in the right direction.

As leaders in medicine, we need to engage and work with all parties in our efforts to improve our healthcare system for the greater good. However, we cannot leave our patients’ destiny and that of medicine in the hands of others. Physicians may not be able to reform our health care system overnight, but we must prevent the health care system from destroying medicine. Remember that our patients look to physicians as trusted leaders for health care solutions, not to the government.

Excessive Government Red Tape Gets in the Way of Delivering Quality Patient Care

Russ Kridel, MD goes up to capital hill to meet with members of Congress

This past year, fighting the burgeoning regulatory burdens and government red tape that contract the time physicians can spend with patients, was one of the top priorities of the Harris County Medical Society during my tenure as president.

We spent substantial time educating our U.S. Congressmen and Texas Legislators about the accumulation of compliance issues that are overwhelming physicians’ offices. They all seemed receptive, but Representatives Brady and Poe have particularly embraced our causes. The opening of health insurance marketplaces and all the new rules and regulations under the Affordable Care Act (ACA) have increased our challenges. Physicians are right in the center of the paths of multiple, colliding fronts in the form of more federal and state regulatory requirements. Physicians are caring for patients and managing the piles of paperwork that the government and other healthcare organizations and executives have created for them. Doctors are now consumed with checking boxes, implementing EMRs and transitioning to a new coding system for billing—all while seeing increasing patient loads and meeting increasingly steep clinical demands.

U.S. physicians commit about 20 percent of their time to administrative tasks and the number is growing. Wouldn’t that time be better spent delivering health care?

SGR: The Not “Sustainable Growth Rate”

In 1997, Congress created the Sustainable Growth Rate (SGR), a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, in just a few short years, health-care costs far outpaced economic growth, which created a multi-billion dollar shortfall in funding for Medicare payments. Since 2003, Congress has approved “doc fix” bills that appropriate more money to Medicare funding in order to avoid cuts in the Medicare reimbursement rates for doctors. Recently, Congress passed a ‘doc fix’ bill for the 17th time in 11 years. In essence, kicking the can down the road once again.

The Medicare Sustainable Growth Rate (SGR) payment system to physicians was never sustainable, never a growth rate and always unfairly discriminatory against physicians. How physicians have been able to keep their doors open to Medicare patients for so long while under a 13-year price freeze when practice expenses have skyrocketed is only answerable by the altruism and personal commitment that doctors have for their patients.

The problem going forward with Congressional compromise and wheeler-dealer arrangements in replacing the SGR is simply that future reimbursements may be based on compliance requirements and so-called quality measures that have unproven clinical relevance and may be more costly than helpful. It is laudable that when Congress passed the Medicare Act (Title XVIII) in the 1960s, the original language specifically said: “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee.” It is distressing to see the absolute disregard of that principle as Congress and the Executive Branch take every opportunity to interpose themselves between the patient and the doctor. Those who have neither a license to practice medicine nor the education to deliver medical care seem to take pleasure in the erosion of physician autonomy and medical decisions, which should be based on the individual needs of the patient rather than on a bureaucratic practice or cost parameter.

While progress has been made in reaching a bipartisan agreement to repeal the Sustainable Growth Rate (SGR), Congress must continue to work to resolve outstanding issues. Congress needs to treat physicians fairly and stop undervaluing our needed services to patients. And we, as physicians, need to continue to fight, to be vocal and to take a leadership role in SGR reform.

Shut Out Sugar Campaign On A Roll

HCMS sponsored Shut Out Sugar brochure

Not only is excessive sugar in the diet dangerous to overall health, it contributes immensely to the obesity epidemic we now face and has led to the huge increase in Type II diabetes we see in younger ages. Sugar sweetened beverages have been found to make up half of the increased sugar in our diet, and drinking one less sugar sweetened beverage a day, such as a cola, would dramatically improve our health. During my tenure as president of the Harris County Medical Society (HCMS) in 2013, one of my key initiatives was to create the Personal Responsibility Committee. This committee developed the Shut Out Sugar program, which included a brochure and website, to increase patients’ awareness of how sugar-sweetened drinks increase their risk of diseases, as well as adding to the waistline. The brochures have been distributed to physicians, schools and many government related agencies and non-profit groups helping to battle the obesity epidemic and is available through HCMS. HCMS was fortunate to receive grant funding from the Texas Medical Association Foundation to assist with the Shut Out Sugar campaign. I am so pleased to see physicians and other members of our community embrace the Shut Out Sugar campaign. It is gaining some great momentum. Please check out the Shut Out Sugar educational video done by Dorothy Cohen Serna, MD and North Cypress Wellness posted on YouTube. Feel free to share the YouTube video and Shut Out Sugar website links with your entire social media community. The more people that get exposed to our message, the greater the positive impact on the health of the members of our community.